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EHR systems for different hospitals ‘unfavourable’ option – HSE committee

By Kieran Feely - 01st May 2023

EHR systems

The new HSE technology and transformation committee has described as “unfavourable” the option of having different electronic health record (EHR) systems in various hospitals, the Medical Independent (MI) can report.

At its meeting on 28 November, a presentation was made by interim Chief Technology and Transformation Officer Mr John Ward on potential options for an EHR for the health service. The first option was a single system across the country.

“While there are benefits to a single system… there are already other EHR systems in use throughout the service,” according to the minutes, which were received by MI following a Freedom of Information (FoI) request.

“The second option is to have the same EHR technology, but multiple deployments, this would also have a shared care record, which is currently being developed. A shared care record would have a patient’s information aggregated from different locations and would also allow patients to access their records directly.”

The third option outlined was to allow for different EHR systems in hospitals. 

“The third option requires the ability to aggregate patient information from multiple systems, and therefore a focus on interoperability and data standards would be critical in the selection of such systems.”

The committee, which was formed last year, agreed that the third option was “unfavourable”.

However, as some hospitals currently have different EHR systems which are functioning, “a transition to a common system may be challenging.”

A HSE spokesperson told MI that “no decision [has] been taken on the EHR option that will be pursued”.

A decision “will be informed by” the Digital Healthcare Strategic Framework (2023- 2030), which is currently being finalised by the Department of Health (DoH).

Meanwhile, documents released by the Department of Public Expenditure and Reform (DPER) and the DoH under FoI law reveal tension between the two Departments over the e-health project.

The records show that the DoH intended to implement an EHR across three areas: Acute hospitals, community care, and integrated care.

The acute hospitals EHR business case was sent by the DoH to DPER on 21 December 2018. In his letter, Mr Muiris O’Connor, Assistant Secretary, DoH, requested approval to initiate a national EHR procurement process.

The DPER response was issued on 24 January 2019 by then Assistant Secretary, Mr David Moloney. He said his Department had understood that the model was to be applied first to the New Children’s Hospital.

“At no stage has any approval or sanction been provided for the roll-out of either a [New] Children’s Hospital EHR or a national EHR. The public procurement guidelines clearly set out that before any procurement process is started approval and funding for the project should be secured. There are very clear sanctioning processes in place for complex projects of this scale and it is not appropriate for any Department to try to advance a project without adhering to these steps,” wrote Mr Moloney.

In his reply on 12 February 2019, Mr O’Connor stated that the EHR business case was discussed by both Departments in early 2017 in the context of seeking Government approval and funding for the EHR programme. Following this, Mr O’Connor stated that efforts to secure funding were successful.

“From your letter of 1 August and more recent correspondence, there seems to be a misunderstanding about the scale and scope of what is being proposed. We are very clear that our objective is to deliver a full electronic health records programme that supports integrated care across the full spectrum of health and community care services across the country,” wrote Mr O’Connor.

“We wish to discuss this core point with you because it appears we keep getting pushed back to the starting line when we have worked so steadily over the past three years to ensure full compliance with best practice in public procurement and to progress the roll-out of EHRs in a manner that supports and implements national digital and national data strategies in Irish health and social care,” Mr O’Connor stated.

It was revealed earlier this year that the business case for the national EHR was rejected by DPER. See news feature

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